HomeMy WebLinkAbout0498 MAIN STREET (CENT.) - HAZMAT 01
JZA. A7-
TOWN OF BARNSTABLE -UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATIO'N
'
ADDRESS: `l -/ AI IT`+1!V � MAP NO. V PARCEL NOt l G ✓�l
r /� /�
OWNER NAME: ( I RrAi 6� 1`� ® �� VILLAGE: �
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
TANK INFORMATION
LOCATION OF dfTANK:
CAPAC I TY I. _TYPE L AGE �r40 FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND
00
ZONE OF CONTRIBUTION C I YES L NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C I YES C J NO'Y DATE
GUNSERVATION YJ
CHECK IF N/A y DATE
BOARD OF HEALTH TAG NO-404K ]C ]C ]C ] DATE Lgl?o,
�.:
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
i
t�
1A